Guest Post: Teaching Toilets in an Age of American Ebola

K.A. Woytonik is a PhD Candidate in the Department of History at the University of New Hampshire. In 2013-2014, she was a Research Associate at the McNeil Center for Early American Studies. Her dissertation is a cultural history of the Pennsylvania Hospital in Early Republic Philadelphia.

PennsylvaniaHospitalWilliamStrickland-1A bevy of esteemed scholars across fields have established the devastating effects of early modern epidemics, from Europe’s plagues to the decimation of Native American populations in North America. Epidemics occupied the minds of colonists, who, depending on region and demographics, participated in prevention strategies including quarantine, the destruction of soiled linens belonging to sick individuals, days of fasting and prayer, and immunity-building efforts such as inoculation and changes in diet. In today’s academy, epidemics offer historians avenues of interdisciplinary discussion, as the impact of contagious disease can be read not only in the archive, but in literature, in artwork, and in archaeological findings.

Yet despite the rich scholarship and the historical importance of the subject, there are no epidemics in my research. The Pennsylvania Hospital, the first of several such urban institutions founded between 1750 and 1820 with the explicit purpose of curing “the sick-poor” and “lunaticks,” had little to do with contagious disease—by its own design.[1] Hospital rules dictated that no individual with a disease that could spread would be admitted to the facility. In a time when physicians disagreed on which diseases were contagious, and when many believed that normally non-contagious diseases could become contagious under particular conditions, doctors at the Pennsylvania Hospital erred on the side of caution and refused services to anyone presenting with a cough or lesions, called for clothing to be laundered or destroyed if it could not be cleaned, and discharged patients who became ill after arriving at the hospital. (Interestingly, venereal disease was exempted from the contagious disease ban, but physicians did institute a special charge to admit patients with syphilis.) Even in the notorious yellow fever summer of 1793, despite the active presence of Pennsylvania Hospital physician and bloodletting enthusiast Benjamin Rush in tending to the ill, the Pennsylvania Hospital is absent from the epidemic narrative because it shuttered its doors as fever patients were removed to Bush Hill, away from the center of the city.[2]

This silence speaks volumes to me as a researcher interested in a wide view of health concerns in the early Republic. The role of the Pennsylvania Hospital remained limited to its original mission even in times of healthcare crisis, like the yellow fever outbreaks. Physicians, nurses, stewards, matrons, and apothecaries at the Hospital spent a great deal of time discussing methods of solving the problem of poor people’s poor health. With the Hospital financed by government grants, private donations and endowments, staff had to convince both politicians and private citizens that cuts, bruises and scabies on the city’s working class could be just as damaging to Philadelphia’s economy, stability, and public health as an epidemic.

Historians, myself included, are understandably reluctant to draw too close a comparison of the dynamics of the past with those we experience today. That said, the distinction between great events and chronic concerns in American public health is a historical topic onto itself. This was never more clear to me than in my History of Medicine in America course this fall, a class that spans 1500 to present and takes pre-health students on a historical journey from alchemy to the Affordable Care Act. Of course, the week that the first in-country Ebola diagnosis hit the news was the same day the class was scheduled to discuss privies and the problem of human waste in early American cities.[3]

It was not surprising to me that my undergraduate students were less than enthused to discuss the latrine habits of eighteenth-century Philadelphians. Juxtaposed with raging debates over failed protocols, inadequate hospital equipment and quarantine, the parasite-ridden bowels of the early American urban poor seemed even more distant and banal. As I simultaneously eased fears about the chances of Ebola ravaging central New Hampshire and wove connections between the stinking, effluvious wharves of Philadelphia and the near-constant concerns about illness and (lack of) health in the American past, my resolve was strengthened to facilitate more conversation between these subfields: in the classroom, and in and across disciplines.

Just as early Republic Philadelphia had its makeshift field hospitals and its de facto outpatient clinics, so does medical history have its spectacular and its mundane. Instead of viewing these strains of medical history as separate, we might instead put them together to expose the complicated relationships between widespread, low-grade health problems and the terrifying episodes of infectious disease. This issues were often causal, at times correlated, and other times in opposition to one another. The every-day, common health problems of historical persons may be more obscure and less culturally memorable than pandemics, but they were not unimportant or without impact. Few Americans will contract Ebola; more will die of the flu, and even more will die in car crashes, of heart disease, and as a result of accidents in their own homes.[4] Hospitals must balance resources, training, and preparedness for all of these events, and this is not a modern phenomenon, but rather a defining problem in the history of healthcare institutions in America.


[1] The Charter, Laws, and Rules of the Pennsylvania Hospital (Philadelphia: Collins, Printer, 1859), 5.

[2] Proceedings of the College of Physicians of Philadelphia, relative to the prevention of the introduction and spreading of contagious diseases (Philadelphia: Printed by Thomas Dobson, at the stone-house N⁰. 41, South Second Street, 1798).

[3] “Kaci Hickox, Nurse Who Fought to Ebola Quarantine, To Leave Maine: Report,” The Huffington Post, November 8, 2014; Nancy Shute, “How Hospitals Keep Deadly Germs Like Ebola Virus Contained,” NPR, August 1, 2014; Ebola Guidelines for Airlines, October 15, 2014, Center for Disease Control and Prevention; Holly Yan and Greg Boteiho, “Ebola: Some U.S. States Announce Mandatory Quarantines – Now What?,” CNN, October 27, 2014.

[4] Leading Causes of Death: Data for the U.S. and Final 2010 Data, Center for Disease Control.

2 responses

  1. I would be interested in hearing more about what you teach about sanitation history in Philadelphia. As a historical archaeologist who worked extensively in Philadelphia in the 1980s and 90s, I find the City’s regulation of privy depths from the 1760s (as I recall) to protect drinking water wells important not only for sanitary reform (even if based on odor rather than an understanding of germ theory) but also for it’s implications on the formation of privy deposits. It became a common practice to continue to use privies of deeper than regulated depth, and to dig new facilities to greater than regulated depth then placing “percolation” fills to the bottom regulation elevation. These deposits consisted of broken pottery and glassware deliberately placed. This practice negated the effectiveness of the privy depth regulations, of course. The use of percolation fills continued into the 19th century even long after the privy depth regulations were no longer in force.

  2. Pingback: Sunday Morning Medicine | Nursing Clio


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